Smartphone adds expertise to emergency room
UC Davis physician helps confirm dangerous infection from images seen on phone
Lester Mundel’s leg infection came on with such pain and suddenness that a short trip to pick up his daughter from the airport in San Francisco ended up becoming a two-week stay in the hospital. If it hadn’t been for the quick thinking of a pair of physicians using their smartphones, the 64-year-old Roseville resident might have lost more than just time. He could have lost his leg or perhaps even his life.
Mundel, accompanied by his daughter and son-in-law, sought emergency care at Sonoma Valley Hospital late on the evening of June 3, when the pain in his leg became so intense that he could barely move or consider returning to the Sacramento area. He was treated by David Streeter, an internist at the hospital, who was immediately concerned by what he saw.
“Mr. Mundel had a very nasty looking leg and his heel was a deep purple,” said Streeter, who directs Sonoma Valley’s hospitalist program. He told me the infection had virtually popped up overnight, so I suspected it was more serious than the typical cellulitis that we see daily in hospital practice. We drew tissue and blood cultures to identify the infection, but time was of the essence and we could not wait for culture results. Within two hours, Mr. Mundel’s temperature had spiked to 106. Something ominous was occurring, and I needed another opinion quickly.”
Streeter contacted his colleague, Javeed Siddiqui, an infectious disease specialist 72 miles away at UC Davis Medical Center in Sacramento, who has provided Sonoma Valley Hospital medical staff with weekday consultations via a telemedicine connection for nearly two years. Because it was late in the evening and he was at home, Siddiqui did not have easy access to the usual videoconferencing connection. The only option was to use their smartphones to share and view the images of Mundel’s infected leg. Within minutes, Siddiqui was viewing the photos and using the phone’s zoom-in feature to get a virtual close-up of the infection.
“The images I saw on my phone gave me all the information I needed to recommend that the surgeon be called in.”
— Javeed Siddiqui
To Siddiqui, the patient’s problem also suggested more than just a common infection. It appeared to be necrotizing fasciitis, a fairly rare condition that quickly can be life-threatening when not treated immediately and aggressively. He urged Streeter to contact the hospital’s on-call surgeon to remove the infected tissue from Mundel’s leg and foot.
Commonly known as "flesh-eating" bacteria, necrotizing fasciitis can be difficult to diagnose in its early stages. It may appear as a routine illness or injury, but can get rapidly worse. It typically is caused by the same bacteria that cause strep throat. In extreme cases, it can be life-threatening because it destroys the soft tissue beneath the skin and often is coupled with toxic shock syndrome, which can result in multiple organ failures. In Mundel’s case, the infection had spread within hours from his calf all the way up his entire leg.
“The images I saw on my phone gave me all the information I needed to recommend that the surgeon be called in,” said Siddiqui. “I didn’t think we were that far from having the patient’s blood pressure drop to dangerously low levels if the infection wasn’t stopped.”
What is telehealth?
It can be difficult for a patient to drive the many miles it may take to reach a specialist at the UC Davis Medical Center in Sacramento. If there are transportation challenges or a medical condition requiring immediate attention, telemedicine is the key to accessing the physician who can assist with a diagnosis and treatment plan.
The UC Davis Telehealth Program partners with community hospitals and clinics throughout California to provide physicians and patients in a variety of communities with access to specialized medical care and education through the use of telecommunications technology. Using high-speed data lines that link to video units at both sites, physicians and patients at outlying hospitals and clinics engage in live, interactive consultations with UC Davis specialists.
To see telemedicine in action, view this news clip (wmv).
For more information about the UC Davis Telehealth Program, visit www.ucdmc.ucdavis.edu/cht/
Bolstered by his colleague’s opinion, Streeter had Mundel on his way to the operating room that night, where a surgeon operated in five places to remove the infected areas of tissue. By using their smartphones to quickly consult about the case, Streeter and Siddiqui likely saved their patient from more dire complications.
“The surgeon warned me as we went in that he might have to take my entire leg,” said Mundel, who thinks the infection may have started with a small cut on his foot. “That’s how bad things looked. I really didn’t think much about smartphones at the time, but it’s nice to know there was another person with expertise overlooking my case and being able to help, too.”
Because the infection was so severe, Mundel has spent nearly two weeks recuperating at the hospital following his surgery. He’s receiving massive doses of antibiotics and being monitored to ensure the infection has been stopped completely.
“Whether it’s a routine telemedicine connection or the use of a smartphone in a critical care situation, digital technology has empowered the practice of medicine in amazing ways,” added Siddiqui, who also serves as associate medical director of the UC Davis Center for Health and Technology. “By linking the skills, experience and decision-making of a clinician with telecommunications technologies, physicians are able to increase the availability and effectiveness of high-quality health care. Medicine in the digital age truly benefits everyone.”
Streeter and Siddiqui are continuing to use regularly scheduled telemedicine consultations between Sonoma and Sacramento to discuss infectious-disease cases. They also recognize there’s now another way to connect in critical situations — a connection that’s already proven to be picture perfect.
“I essentially have an infectious disease specialist in my back pocket at all times,” said Streeter. “Being able to access specialty-care experts so quickly is a huge plus because it really adds to the quality of care I can provide a patient.”